Lower Back Pain in Athletes

Back pain is a frequent complaint in adults, usually a result of advancing age and spurts of over activity. However, back pain in children, especially in athletes, is an unusual symptom and should always be taken seriously. Sometimes it is due to muscle soreness from increases in training or bruises from direct contact. However, it can also be a sign of more serious problems.

The bones that make up the back have 3 jobs. Most important, they provide protection for the spinal cord. At the same time, they have to provide strength and stability to support our body weight as we stand, run, and jump. They also have to allow the flexibility for us to bend and twist in all directions. Back pain in athletes is most commonly caused by 1 of 2 mechanisms. The first is repeated hyperextension of the spine (“bending back” or “spinal overload syndrome”), as seen in gymnastics, dancing, lacrosse, diving, and other sports. Repeated hyperextension places a lot of stress on the structures of the back that provide flexibility.

Just as a paper clip will break if bent a small distance repeatedly, the bones in the back will get sore and eventually could develop a small break if the back is repeatedly hyperextended. The second mechanism of back pain involves either being hit in the back or stretching the muscles too far and occurs frequently in contact sports or when someone is trying to lift too much (weight training). Although common in adults, disc problems are unusual in children.

Management

With the initial complaint of back pain, check for any other symptoms. If fever is present, or if the pain is severe, persistent, or associated with numbness or tingling in the back (or going down the legs), call your primary care physician right away. These symptoms could be the sign of a serious problem.

Initial treatment of pain should be complete rest (no sports participation until the pain is gone) and anti-inflammatory medicines like ibuprofen or acetaminophen. Ice is frequently helpful for acute pain relief. Although heat can eventually be used to relieve muscle spasm, it should never be used in the first 24 hours after an injury.

If the pain does not get consistently better over a few days and is not gone in 3 to 4 weeks or if the pain is worse when you bend backward, call your primary care physician. Further tests may be needed to determine the cause of the pain. This is especially true if you are involved in any sport that involves bending back, like gymnastics or dance.

Rehabilitation will never be successful until the back is adequately rested (pain free). Rehabilitating a back injury usually involves strengthening the abdominal and back (“core”) muscles and increasing the flexibility of the hip and thigh (hamstring) muscles. Exercises that involve arching of the back should not be done during rehabilitation. Stretches should be done gently for 30 seconds without bouncing or pain and repeated for each leg. Strengthening exercises should be done in 2 sets of 10 repetitions, 2 or 3 times a day.

Stretching

Hip flexors stretch: Kneel behind a chair. Bring one knee up to the back of the chair, while tilting your pelvis forward until you feel a stretch on the other side of the hip.

Hamstring stretch: Lie on your back with your knees bent. Loop a belt around one foot, and raise your leg up while pulling the foot toward you until you feel a gentle pull in the hamstring.

Strengthening

Abdominal crunches: Lay on your back with your feet against a wall so that your hips and knees are both at 90º angles. Lift up your head until you feel the abdominal muscles tense up, and hold it for a few seconds before relaxing. Moving the shoulders from side to side while the head is up will strengthen the lateral abdominal walls.

Planks: Lay on your stomach, resting on your elbows, and lift up your midsection so that all the body weight is on your elbows and toes. Try to keep the entire body perfectly straight. Hold for a few seconds, then relax.

Quadruped: Start on your hands and knees, maintaining a straight upper back, and lift 1 arm straight out next to your ear and then extend the opposite leg out behind you. Hold for 5 to 10 seconds, and repeat with the opposite limbs.